Relationship between age, pseudophakia, diabetes mellitus and endothelial cell density in corneal donor tissue: a 10-year retrospective study.

OBJECTIVE: To evaluate the independent and combined effects of age, diabetes and pseudophakia on endothelial cell density (ECD), assessed both as a continuous measure and as a binary outcome using a commonly used reference threshold of <2000 cells/mm². METHODS AND ANALYSIS: This retrospective, observational, cross-sectional study analysed 681 donor corneas from 350 individuals recorded in the Rabin Medical Center, between 2014 and 2024. Baseline donor variables included age at donation, sex, diabetes status and lens status. ECD was measured centrally using Konan CellChek specular microscopy, which quantifies ECD based on manual marking of central endothelial cell centres. Generalised estimating equations were used to account for within-donor clustering, modelling ECD as both continuous and binary variables. Potential effect modification by pseudophakia was assessed in stratified models. RESULTS: Mean donor age was 62.8 years; 37.1% had diabetes and 22.8% were pseudophakic. Diabetes was associated with lower ECD overall (β = -106 cells/mm²; 95% CI -205 to -7) and with increased odds of ECD <2000 (OR=1.91; 95% CI 1.13 to 3.21). However, this effect was only significant in non-pseudophakic eyes. Pseudophakia (OR=2.88; 95% CI 1.80 to 4.63) and older age (OR per year=1.05; 95% CI 1.03 to 1.07) were consistently associated with lower ECD and a higher likelihood of falling below threshold. CONCLUSION: Older age and pseudophakia were independently associated with increased risk of low ECD. In subgroup analyses, diabetes was linked to lower ECD only in non-pseudophakic eyes. However, formal statistical testing for interaction between diabetes and lens status was not significant.